Diabetes 101 Nutrition Exercise Therapy for Diabetes Management

Diabetes 101 Nutrition & Exercise Therapy for Diabetes Management Preventing Complications from Diabetes

Course Objectives • Define and describe the different types of diabetes. • Describe the symptoms of a high or low blood sugar and how to treat a low if needed. • Discuss the different types of medications used to treat diabetes. • Name ways you can better manage your diabetes. • Understand how healthy eating and physical activity relate to diabetes management. • Explain the importance of monitoring blood sugar and Hb. A 1 C. • Recognize the need for regular check-ups and developing a sick day plan with your provider. • Describe steps you can take to prevent future complications.

Part 1: Diabetes 101

What Happens When I Eat? Food is broken down into glucose Glucose = Sugar Pancreas makes insulin and helps move glucose in the blood into cells Glucose helps the cells produce energy Novo Nordisk: Changing Life with Diabetes

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What’s the Difference? Novo Nordisk: Changing Life with Diabetes

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What is A 1 C? • A 1 C gives the you the average blood glucose over a 3 month period, but mostly in the past 30 days • Since this is an AVERAGE, it only represents the middle ground • You could be having really HIGH blood glucose and really LOW blood glucose

How is Diabetes Diagnosed? Diabetes - A 1 C > 6. 5% - Fasting glucose >126 - 2 hrs after meal >200 - Random glucose >200 with symptoms of high blood sugar Pre Diabetes - A 1 C 5. 7 -6. 4% - Fasting glucose 100 -125 Normal - A 1 C < 5. 7% - Fasting glucose < 100

Signs of HIGH Blood Sugar • Frequent urination • Increased thirst • Hunger • Blurred vision • Fatigue • Headache Novo Nordisk: Changing Life with Diabetes

Signs of LOW Blood Sugar • Heart palpitations • Shakiness • Anxiety • Sweating • Hunger • Tingling sensation • Weakness • Sleepiness • Dizziness Novo Nordisk: Changing Life with Diabetes

Treating a LOW: Rule of 15 • Check your blood sugar!!! • If your blood glucose is LESS than 80: – Eat/drink 15 grams of sugar » 4 oz of Orange Juice » 4 oz of REGULAR Soda » Chew 3 -4 Lifesaver Candies » 3 Glucose Tablets » 1 Tube of Glucose Gel • Recheck your blood sugar in 15 minutes and repeat until blood glucose is greater than 80

Why Should I Monitor BG? • Damage to the body’s cells occur when blood sugars are ABOVE 180 constantly • It gives you an idea of what happens on a daily basis with your blood sugar • It helps YOU manage your diabetes

Goals & Treatments

Goals for Diabetes • Based on the 2015 Guidelines from the American Diabetes Association (ADA): – A 1 C: < 7% – Fasting Sugar: 80 -130 – 2 -hours after meal sugar: < 180 – LDL “Bad Cholesterol”: < 100 – Blood Pressure: < 140/90

Treatment Options • Oral medications and injectable medications • Sometimes you may need to take more than one medication because they work in different areas of the body

Medications That Work in the Liver • Examples: – Glucophage® (metformin) Take with FOOD! – Actos® (pioglitazone) – Januvia® (sitagliptin) – Onglyza® (saxagliptin) – Tradjenta® (linagliptin)

Medications That Work in the Pancreas • Examples: – Micronase® (glyburide), Amaryl® (glimepiride), Glucotrol® (glipizide) – Starlix® (Nateglinide), Prandin® (repaglinide) Take 15 -30 min before meals BUT you MUST eat to prevent low blood sugar

Medications That Work in the Muscle • Examples: – Glucophage® (metformin) – Actos® (pioglitazone)

Medications That Work in the Stomach • Examples: – Victoza ®, Byetta ®, and Bydureon ® (Injectables) Take Byetta 30 -60 minutes before meals – Januvia® (sitagliptin), Onglyza® (saxagliptin), and Tradjenta® (linagliptin)

Insulin • Provides the body with insulin which helps bring glucose into the cell and decreases your blood sugar • Examples: – Long Acting • Lantus, Levemir – Short or Rapid Acting (Meal Time Insulin) • Humalog, Novolog, Apidra Make sure you EAT!!!!!

What Can I Do To Manage My Diabetes? • • Follow-up with your doctor at least 1 x/year Attend regular check ups with your doctor Take medications properly Eat right and exercise Monitor blood sugar! Comprehensive eye exam and foot exam yearly Check feet daily Flu vaccine yearly

Part 2 - Nutrition Therapy for Diabetes Management

How Do You Control Blood Sugar With Food? Meal Planning • Consistent meal times • Consistent carbohydrates • Combine protein foods with carbohydrates

How Nutrients Affect Blood Sugar CARBOHYDRATE PROTEIN FAT

Total Carbohydrates Count Carbohydrates give energy ENERGY But too much carbohydrate can raise blood sugar above your target range

Total Carbohydrates Count Men 45 -60 grams per meal 15 -30 grams per snack Women 30 -45 grams per meal 15 -30 grams per snack

Carbohydrates (CHO) in Each Food Group

Breads, Cereals, Grains & Starchy Vegetables Have CHO Each serving has about 15 grams carbohydrates One serving is: • 1 slice of bread • ¼ bagel • 1/3 cup cooked rice, pasta or oatmeal • ½ cup starchy vegetables – potatoes, beans, peas, corn

Fruits Have CHO Each serving has about 15 grams carbohydrates One serving is: • 1 small fruit (size of tennis ball) • ½ cup fruit • ½ large banana • 17 small grapes • 2 Tbsp raisins or dried fruit

Non-starchy Vegetables Have Very Few CHO Each serving has about 5 grams carbohydrates One serving is: • 1 cup raw vegetables • ½ cup cooked vegetables

Dairy Products Have CHO Each serving has about 15 grams carbohydrates One serving is: • 8 oz cow’s milk • 6 – 8 oz plain yogurt – Flavored yogurt = 18 – 45 g! Check the label!

Meats & Protein Alternatives Have No CHO • Meats, eggs and cheeses have very little CHO but can be high in fat and cholesterol • Beware of breading and sugary sauces • Protein alternatives have very little CHO: – Nuts, nut butters, seeds, soy & tofu – Veggie burgers DO have CHO – check the label!

Sweets & Sugars Have CHO • Count towards total carbohydrates • ‘Sweets’ have little nutritional value but can be high in fat and calories, which can cause an increase in weight and triglycerides • Sugar free products still have CHO • Limit ‘sweets’ to 1 -2 servings each week

Portion Sizes • • • 3 oz of meat = size of deck of cards 1 cup = size of baseball ½ cup = ice cream scoop 1 serving of fruit = size of baseball 1 Tbsp of fat = thumb tip 1 serving of bread = size of CD

Use the Plate Method ½ Plate Veggies ¼ Plate Protein ¼ Plate Starches, Grains, Fruit or Milk

Reduce Saturated Fat Roasting Baking Broiling Grilling • Remove skin from poultry & choose white meat • Choose lean proteins – chicken, turkey, fish, tofu or pork tenderloin • Eat fewer high-fat foods – cold cuts, hot dogs, sausage, bacon & fried food • Use less fat in cooking or use cooking sprays

Meal Planning: Timing • Eat every 3 -5 hours • Do NOT skip meals • Try to eat at the same time every day • Eat a snack if meal is delayed

Reading a Label Always check the serving size! Look for total CALORIES Check the FAT Nutrition Facts Serving Size 1 cup (236 g) Servings Per Container 2 Amount Per Serving Calories 230 Calories from fat 120 % Daily Value* Total Fat 14 g 22% Saturated Fat 7 g 35% Trans Fat 1 g Cholesterol 40 mg 13% Sodium 950 mg 40% Total Carbohydrate 16 g 5% Dietary Fiber 2 g 8% Sugars 3 g Protein 11 g Vitamin A 20% Vitamin C 0% Calcium 2% Iron 6% Check for CARBS *Check the first 3 items on the ingredients list for hidden fats and sugars

Water & Non-Calorie Liquids = 8 cups per day Sugar-free drinks do count, but water is best! SF Tang Diet Soda Herbal Tea Crystal Light Flavored Water Coffee or Tea

Your Meal Plan: Deciding What to Eat Lunch Sample 2 slices whole wheat bread 2 oz of turkey 1 slice of 2% cheese 1 Tbsp lite mayo Lettuce/tomato 1 small piece of fruit Noncalorie beverage Total Carbohydrates 30 grams 0 -2 grams 15 grams 0 grams = 45 grams

Exercise Therapy for Diabetes Management

Total Carbohydrates Count Good News About Physical Activity Lose weight Gain energy Lower risk of heart disease Increase well-being Possibly reduce the need for some medications Improve overall health

Keep It Fun! Add Variety to Your Daily Routine Choose Enjoyable Activities Enjoy Activities with Friends

Blood Sugar & Exercise Blood Glucose Level Guidelines Lower than 100 mg/d. L (5. 6 mmol/L) Your blood sugar may be too low to safely exercise. Eat a carbohydrate containing snack. You're good to go! This is a safe pre-exercise zone. 100 to 250 mg/d. L (5. 6 to 13. 9 mmol/L) > 250 mg/d. L (13. 9 mmol/L) or higher Your blood sugar may be too high to exercise safely. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

Diabetes & Exercise • Exercise only when feeling well • Become familiar with blood glucose patterns • Know the symptoms of highs and lows

Diabetes & Exercise • 30 – 45 minutes of exercise is safe when diabetes is under good control • Eat a meal 1 – 3 hours before exercise • Insulin – Administer insulin more than 1 hour before exercise – Administer insulin in abdomen – Avoid extremity injection

Diabetes & Exercise • • During exercise, drink plenty of fluids Remember: sports drinks contain sugar After exercise, monitor your blood glucose Wear shoes and socks at all times Always wear properly fitted footwear Check your feet after every session Consult your physician if any symptoms develop during or after exercise

Where Can You Find Shoes & Socks for Exercise? • Pharmacies • Podiatrists – Wilmington Foot & Ankle • Omega Sports (Oleander Dr) • Diabetic socks can be purchased at the EFC, most pharmacies and large retail stores – Dr. Scholl’s brand

What is Exercise? • Exercise is anything you want it to be – walking the dog, cleaning, taking the stairs, working out at the Employee Fitness Center • Focus on duration over intensity – three 10 min sessions or one 30 min session; every minute counts!! • Adding to your normal, daily activity is important – if you walk all day at work, you still need planned exercise or additional physical activity in your routine

Time to Get Started Want to get started now? Your safety is very important to us. Follow the guidelines we have provided, and remember that you can always contact a trainer at the EFC for more specific advice on physical activity and exercise. Always seek help with each new exercise. Can’t start the 12 to. Life just yet? Try a group exercise class offered at the EFC, take a walk with some friends or coworkers during lunch, take the stairs, or even contact a trainer for an appointment. Not sure if you can participate in any of the NHRMC EFC programs? Remember our guidelines, and seek help when needed. Your team is here to help you. For more information on outdoor resources for exercise and physical activity in your area, contact a member of the Diabetes Health Plan Team or an EFC staff member! Even if you live farther away, always remember that you are not alone.

Preventing Complications from Diabetes

Preventing Complications • Having pre-diabetes and diabetes puts you at a higher risk for developing other health problems HOWEVER… • If you understand the risks, you can take steps now to lower your chance of diabetes related complications

Managing Diabetes • What percentage of diabetes is managed by you vs. your healthcare provider? • 20% of your diabetes control is managed by your healthcare provider • 80% is managed by you

Preventing progression of DM • • • Healthy eating Exercise Monitoring BG Taking medications Stop smoking

• • • Long Term Complications of Poorly Controlled Diabetes Heart Disease and Stroke Kidney Disease Eye Complications Nerve Damage Foot Complications Skin Complications Depression Sexual Dysfunction Gum Disease The good news is: Better control = Less complications

Heart Disease and Stroke • People with diabetes are 2 x more likely to have heart disease or stroke than people without diabetes • How can we prevent long term complications? – Cut out sugary and fattening foods – Daily exercise – Get your lipid panel done 2 x/year http: //www. diabetes. org/living-with-diabetes/complications/mens-health/serious-health-implications/heart-disease-and-stroke. html

Kidney Disease • The kidneys clean our blood • High blood sugar can put too much stress on the kidneys and can cause damage over time • How is the long term complication prevented? – Get your kidney function tests 2 x/year http: //www. diabetes. org/living-with-diabetes/complications/kidney-disease-nephropathy. html

Eye Complications • Diabetes can damage the blood vessels of the eyes, potentially leading to blindness • Diabetes can also cause glaucoma or cataracts • How is the long term complication prevented? – Get a comprehensive eye exam by an optometrist or ophthalmologist 1 x/year http: //www. diabetes. org/living-with-diabetes/complications/mens-health/serious-health-implications/blindness-or-vision-problems. html

Nerve Damage (Neuropathy) • High sugar can harm the walls of the tiny blood vessels that connect to your nerves • Described as a tingling, numbness, burning or pain in legs or fingers • How is the long term complication prevented? – Get a foot exam by a physician 1 x/year – Use proper foot care http: //www. diabetes. org/living-with-diabetes/complications/mens-health/serious-health-implications/nerve-damage. html

Foot Care • Check your feet every day – Look at your bare feet for red spots, cuts, swelling, and blisters • Wash your feet, dry, and moisturize every day – Rub lotion over the tops and bottoms but not between your toes • If you can see and reach your toenails, trim them – File the edges with a nail file • Protect your feet from hot and cold – Never use hot water bottles, heating pads, or electric blankets • Never walk barefoot – Wear comfortable shoes that protect your feet – Check inside your shoes before wearing them • Keep the blood flowing to your feet – Don't cross your legs for long periods of time

Depression • Studies show that people with diabetes have an increased risk of depression • How is the long term complication prevented? – Exercise and see your physician at least 1 x/year, or as often as the two of you feel is appropriate • Don’t be afraid to reach out for help – Employee Assistance Program (EAP) 1 -800 -822 -4847 (24 hours a day) – 5 free sessions/year

Gum Disease • There is an increased risk for gum disease because diabetes decreases your ability to fight bacteria that invade the gums • How is the long term complication prevented? – Brush and floss regularly – Have a dental exam at least 2 x/year http: //www. diabetes. org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/diabetes-and-oral. html

Reducing Risk & Sick Day Management

Reduce Risk: Quit Smoking • This is 1 risk factor YOU can control • IT IS NEVER TOO LATE TO QUIT • Smoking and diabetes have a lot of the same complications • Talk to a health care professional if you are interested in quitting • 1 -800 -Quit-Now

Reduce Risk: Get Vaccinated • Flu vaccine 1 x/year – Free to all employees and dependents in Employee Health! • Pneumonia vaccine 1 x before 65, 1 x after age 65 • Hepatitis B vaccine 1 time series between age 19 -59

Know your ABC’s Target: Less than 7% Target: Less than 140/90 Target: LDL “bad cholesterol” Less than 100

A 1 C • A 1 C – your doctor will likely tell you how often to have this lab drawn • For the DHP: 2 x/year at Employee Health As a general rule: A 1 C < 7% 2 x/year A 1 C > 7% 4 x/year

Blood Pressure • Blood pressure will be checked at every doctor visit and Employee Health & Clinic visit Systolic Diastolic (top number) (bottom number) 140 or less 90 or less

Cholesterol • Cholesterol will be drawn at least 2 x/year at Employee Health & Clinic Sex Male Total HDL Cholesterol < 200 > 40 Female < 200 > 50 LDL TG < 100 < 150

Daily Monitoring Goal fasting BG before meals: 80 -130 mg/d. L Helps you see how food, physical activity and medications affect your blood glucose level Goal 2 hours after the start of a meal: Less than 180 mg/d. L

Sick Day Management • Discuss your sick day plan with your physician • Make sure you get an annual flu vaccine www. jimchines. com

S. I. C. K. S I Is for Sugar testing more often C Is for Carbohydrate - keep intake as normal as possible K Is for Keep well hydrated - drink at least 8 oz of calorie free fluids every hour Is for continue to take your Insulin or oral medications http: //www. health. gov. sk. ca/Type-2 -diabetes-on-insulin-sick-day-mgmt

Things To Do on a Daily Basis • • • Eat healthy Keep active Check your sugar Reduce risky behaviors – smoking, drinking alcohol Practice proper foot care habits Wear proper footwear Brush your teeth and floss regularly Manage daily stressors Ask for help when necessary AADE 7 Self Care Behaviors – Reducing Risk

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Contact Information For appointments with Dietitian or Pharmacist Contact Dee Freeman at 667 -5183 or Diabetes. Pharmacy@nhrmc. org For other questions related to the Diabetes Health Plan, contact the DHP Administrator at 667 -5959 or wellness@nhrmc. org DHP Hotline 667 -7777

References • American Diabetes Association http: //www. diabetes. org/ • Novo Nordisk http: //www. cornerstones 4 care. com/

Other Resources • http: //www. health. gov. sk. ca/Type-2 -diabeteson-insulin-sick-day-mgmt • http: //www. diabetes. org • 1 -800 -QUIT NOW- for smoking cessation